Teenage Pregnancy: An Ethics Question

This post on Not House’s blog set me thinking about an ethically dicey question (Medical ethics has always been one of my pet peeves): Teenage Pregnancy and Consent.

In this post, I am going to state an ethics issue, to which you may feel free to post your views/comments on (regarding the ethical implications of the same). I am taking this case directly from Not House’s blog mainly because I liked the way he presented it, and there seem to be numerous nuances to the same. So here is the case:

A 15 year old obese girl came to the ED complaining about headaches and feeling faint. While in the ED waiting room with her parents, she had a seizure, was brought to the trauma room, and proceded to have yet another seizure. The workup eventually revealed she was 31 weeks pregnant, and was suffering from eclampsia. After being told this, she was asked what she wanted to do, and requested they do a C-Section and not to tell her parents.

What do you think are the ethical issues complicating this particular problem? And how do you think they can be tackled?

Feel free to post your views as comments. I will post my take on these issues in a later post.

[UPDATE: I realize that there may be variations in the setting from one nation to another owing to different laws and rules, so, whilst I will be talking of the Indian perspective (which I am aware of) mainly in the follow up discussion text, I would like to keep it broad. So, I would like to say that you too should keep the discussions running on a broad spectrum, rather than concentrating on the nitty gritties.]

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

0 Comments

wow….tough situation to be in. While the girl is still a minor, making it necessary for her parents to be notified and provide consent for surgery for the c-section, the girl is also now the mother-to-be of this baby, and since it is her baby and her body, it would seem to me that she would have the final say.

I don’t know if this is an ethical issue persay, but I while I am all for girls having the power to ask that abortions, etc. be kept confidential, I don’t think that the parents deserve to be straight out lied to when they’ve been put through a situation like the one above. Keeping things confidential is easy when it’s merely not contacting parents over the phone, but it’s not really fair to ask a doctor to lie to your parents’ faces about why you’ve had seizures and surgery. While I’m not too sure on the medical details, I’m assuming this girl is going to require some care from her parents over the next couple weeks, or at least some consideration, as a C-section takes a while to recover from. How do you explain to the scared parents without telling them she’s had eclampsia and a C-section? I think my concern is more for the doctors than the girl, but I suppose that’s just my disapproval of teen pregnancy clouding my judgement.

coming from the American South, I feel that the girl should be able to make such a decision on her own. I think reproductive decisions are the most personal matters possible, regardless of age. I think the only proper thing to do would be to try to counsel the girl into telling her parents, but again, this is not coming from an Indian perspective. My mom gave birth to me at age 15 with little to no social stigma attached, except she had to drop out of high school to take care of me. She did this with her parents knowledge and blessing, and she was married to my father. On a practical matter, if the girl was 15, she would be on her parents insurance and they would find out as soon as they got a 20,000$ bill for the c-section. Not to mention the paperwork and issues with the Department of Human Services and Child Welfare concerning the assumed adoption of the baby. I think the real issue goes back to sex education for children at a fairly young age. 31 weeks pregnant would mean almost 7 missed periods, swollen breasts and other signs that might go unnoticed to the uneducated. Plus, knowledge of proper birth control could have prevented the whole situation. Again, this is coming from a fairly liberal American who comes from a conservative rural area.

First of all, a C-section is not something that can just be done and that’s the end. How could you hide the fact that you just had a C-section? That would require lies within the medical field, as well as lies within her family. What if she then had complications from this C-section later? Who would then be responsible for telling her parents that she had a baby and that was the reasons for her seizure and new complications?

There are so many things wrong with this world, I don’t think the medical field needs to get into the business of telling lies and hiding MAJOR (a baby is definitely major) medical history. If this child were no longer in the care of her parents, fine, don’t tell them, but she is (I’m assuming) a minor and her parents are responsible for her through the time that she is an adult. Yes, it may be embarrassing, but so many things could go wrong that not telling her parents would be the worst thing to do in this scenario.

My parents would do everything in their power to find out why I had the seizures to begin with, and would not stop until they knew that I was safe. To make them go through that torture for months after the C-section would be unfair to everyone. Maybe it’s because I’m pregnant that I find this so horrible, maybe it’s because I have a 13 year old stepdaughter who I love and adore, or maybe it’s because I respect my parents too much to lie to them about something so major in my life, but I completely think this would be the wrong path for everyone involved.

Lets say that the laws in your area dictate that the girl is able to give consent to the surgery and is legal empowered to make her own medical decisions, and despite all efforts to encourage the patient to share this news with her family, she won’t. How are you going to get around the parents? I don’t know many parents that would willingly swallow “We’re going to operate on your daughter, but I can’t tell you why”.